Senators slam Davis' HMO czar

Published 4:00 am, Tuesday, September 11, 2001

Daniel Zingale, Director of the Department of Managed Health Care, in his office in Sacramento, Calif., on Wednesday, January 24, 2001. Photo by Steve Yeater/ For the Chronicle

Daniel Zingale, Director of the Department of Managed Health Care, in his office in Sacramento, Calif., on Wednesday, January 24, 2001. Photo by Steve Yeater/ For the Chronicle

Photo: STEVE YEATER

Senators slam Davis' HMO czar

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2001-09-11 04:00:00 PDT Sacramento -- Few people in the Capitol can remember an official letter as harsh or unforgiving as the one that recently landed on the desk of a high-level Davis administration official, HMO czar Daniel Zingale.

"You have let us down. More importantly, you have let down the consumers you profess to care about," Senate leader John Burton, D-San Francisco, and Sen. Jackie Speier, D-Hillsborough, wrote to Zingale. "The recent actions by your department have made us question whether we should support its continued existence."

The Aug. 27 letter attacked Zingale for meddling in health care legislation that Speier and others had written. Its tone shocked consumer activists who have watched Zingale's fledgling Department of Managed Health Care go after HMOs and the for-profit medical establishment.

But the letter, lawmakers and consumer groups say privately, masks a more complex and much nastier debate between the state's HMOs and the doctors who work for them. Speier is a big supporter of the California Medical Association,

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which represents 34,000 doctors around the state, and most of the bills Zingale wants to change directly affect the bottom line of doctors.

Consumer groups say the harsh criticism of Zingale left them confused and wondering about the motives.

"If John would sit down a minute and listen to the facts, which he is frequently too impatient to do, he would see that Daniel has done incredible things on the behalf of consumers," said Marjorie Swartz, a lobbyist with the Western Center on Law and Poverty. "I just really can't understand it."

During the past decade, Speier's relationship with the CMA doctors' group has evolved from that of ardent foe to good friend. At the same time, she has built a reputation as a fierce consumer crusader against the HMOs that contract with these doctors.

Speier has hired a doctor as her chief consultant on HMO issues and she carries more bills that would benefit the CMA than any other lawmaker -- bills the Davis administration is threatening in various ways as the legislative session winds down.

Speier has received $27,500 in political contributions from the CMA since 1995. During the first six months of 2001 alone, recent reports show, Speier collected $20,850 from doctors' groups, the CMA political fund and individual doctors.

Most of the HMO-related bills this year have little to do with health care and more to do with contract disputes and the rates doctors are paid.

One measure Speier is carrying would require doctors and HMOs to continue covering patients for a certain period after a contract is severed -- so patients aren't left without health care. But the measure also would mandate a 10 percent premium to doctors, paid by the HMOs, after the contract is severed.

The Davis administration and consumer groups say the premium would, in fact,

give doctors an incentive simply to sever their disputed contracts since they'd get paid anyway. But Speier said Davis would keep doctors in bad contracts that could bankrupt them.

Speier said that she's only interested in helping consumers and that keeping doctors' groups in business is good for patients.

"If they don't have enough money to operate, then patient care is going to be compromised," Speier said. "The HMO doesn't actually provide the health care. It's the physician and the nurse practitioner. We just can't lose sight of that."

Zingale would only comment on the department's positions on certain 2001 bills -- none of which is mentioned in the Speier-Burton letter. But he said the Aug. 27 letter "doesn't capture the good working relationship that Sen. Speier and the department have had for the past year."

Earl Lui of Consumers Union said he was surprised by the letter and said Zingale was a friend of consumers. Beth Capell, a lobbyist with Health Access California said she was deeply troubled to see the letter to Zingale.

Just supporting the CMA at the expense of the HMOs doesn't necessarily help consumers, Capell said, because "there are a lot of issues where the interests of doctors and consumers are different, just as there are a lot of areas where the interests of HMOs and consumers are different."

The CMA, meanwhile, has made Zingale its main target. Last week, the CMA sued Zingale's department because he has promised to release documents about the financial health of various doctor-run medical groups. Speier has opposed the release of the financial documents, saying it gives the HMO unfair advantage in negotiating contracts with doctors. Zingale thinks patients should be warned if their doctor is about to go bankrupt.

A central complaint from Burton and Speier is that Zingale is meddling in the legislative process far too much when he should be concerned about enforcing existing regulations.

"He's an enforcement group," said Burton. "What he should take a position on is: 'Look, you're asking me to take on more than I can do and you better give me more money.' " Steve Thompson, a lobbyist with the CMA, said Speier was one of the early lawmakers to recognize the financial problems of doctors' groups, and he disagreed with assumptions that Speier wanted to bring down Zingale to protect her legislation.

"With issues that are fundamental to keeping the medical system solvent, the department's position has been quite similar to the (HMO) industry," Thompson said. "I'm not putting any aspersions on it. I'm just saying that is a fact."